Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR008987 | GA |
NPI | 1184067456 |
---|---|
Provider Name | Dr. Patrice D Thompson |
First Address | Atlanta, GA 30331-7524 |
Second Address | Atlanta, GA 30331-8013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 11/06/2013 |